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respiratory drugs Flashcards

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1
Q

what is asthma ?

A

chronic inflammatory disorder of the airway- caused by immune mediated immune inflammation

symptoms are a result of inflammation and bronchoconstriction

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2
Q

signs and symptoms of asthma ?

A

Sense of breathlessness
Tightening of the chest
Wheezing
Dyspnea
Cough

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3
Q

what is copd ?

A

chronic obstructive pulmonary disease - non reversible long term that can be characterize by air flow restrictions and inflammation
most often caused by cigarettes

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4
Q

signs and symptoms of copd

A

Chronic cough
Excessive sputum production
Wheezing
Dyspnea
Poor exercise tolerance

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5
Q

Patho of COPD

A

symptoms are mostly a result from chronic bronchitis and emphysema - which take place from an exagerated inflammatory response to smoke

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6
Q

what is emphysema

A

enlargement of the air space within the bronchioles and alveoli brought on by the deterioration of these walls

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7
Q

meds that are used for asthma and copd

A

glucococorticoids ( anti inflammatory agents
bronchodilators (beta 2 agonists )

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8
Q

anti inflammatory drugs are

A

foundation of asthma treatment, taken for long term control

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9
Q

mechanism of action of glucocorticoids?

A

Mechanism of action = suppress inflammation
Reduce bronchial hyperreactivity and decrease airway mucous production

Reduce infiltration and activity of inflammatory cells

Usually administered by inhalation, but IV and oral routes are also options

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10
Q

use of glucocortcoids

A

Prophylaxis of chronic asthma
Dosing must be on a fixed schedule, not as needed (PRN)
Not used to abort an ongoing attack because beneficial effects develop slowly

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11
Q

glucocortcoids are considered :

A

the first line of therapy for for management of inflammatory component of asthma
- persistant asthma patients should use this daily

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12
Q

oral use of glucocorticoids

A

For patients with moderate to severe persistent asthma or for management of acute exacerbations of asthma or COPD
- should be used only when symptoms cannot be controlled with safer medications (inhaled glucocorticoids, inhaled beta2 agonists
Treatment should be as brief as possible

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13
Q

adverse effects of inhaled glucocorticoids

A

Adrenal suppression
Oropharyngeal candidiasis
Dysphonia

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14
Q

averse effects of oral forms

A
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15
Q

why is adrenal suppression an issue with glucocortcoid use

A

prolonged use of glucocorticoids can decrease the ability of the body to make its own endogenous glucocorticoids

  • periods of high stress, bpdy cannot produce glucocortcoids which is needed, patients will have to be given a higher dose of either oral or IV if this is the case
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16
Q

Leukotriene Receptor Antagonists

A

Suppress effects of leukotrienes( promote smooth muscle constrictions , blood vessel permeability , and direct recruitment of inflammatory cells

considered second line agents

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17
Q

how do leukotrine modifiers help patients with asthma ?

A

can reduce bronchoconstriction and inflammatory responses such as edema and mucous secretion

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18
Q

problems with Leukotriene Receptor Antagonists

A

Generally well tolerated but can cause adverse neuropsychiatric effects, including depression, suicidal thinking, and suicidal behavior

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19
Q

Zileuton [Zyflo]
Zafirlukast [Accolate]
Montelukast [Singulair]

A

Leukotriene Receptor Antagonists

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20
Q

what is a mast cell stabilizer

A

Used for prophylaxis, not for quick relief
Suppresses inflammation; not a bronchodilator

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21
Q

mast cell stabilizer mechanism of action

A

Stabilizes cytoplasmic membrane of mast cells, thereby preventing release of histamine and other mediators; in addition, inhibits eosinophils, macrophages, and other inflammatory cells

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22
Q

therapeutic use of mast cell stabilizer

A

Chronic asthma
Exercise-induced bronchospasm (EIB)
Allergic rhinitis

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23
Q

what is a bronchodilator ?

A

symptomatic relief but do not alter the underlying disease process (inflammation)
principal bronchodilators are: beta2-adrenergic agonists

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24
Q

patients that are also taking bronchodilators should also be taking what ?

Study These Flashcards
A

glucocorticoid for long-term suppression of inflammation

25
what do beta 2 adrenergic agonists do ?
activate the beta 2 receptors in the smooth muscle of the lungs , which will relieve the bronchospasm Beta2 agonists have a limited role in suppressing histamine release in the lung and increasing ciliary motility
26
What is a SABA
short acting beta 2 agonist use PRN to stop an ongoing attack taking place, can be taken before exercise to prevent an attack treatment of choice for an attack in the hospital used with asthma and COPD
27
what is a laba ?
Inhaled long-acting beta2 agonists Long-term control in patients who experience frequent attacks dosing is on fixed schedule ---> NOT PRN effective for stable COPD treatment
28
using a LABA as treatment
When used to treat asthma, must always be combined with a glucocorticoid contraindicted to treat asthma alone
29
adverse effects of beta 2 agonists
inhaled : Tachycardia, angina, tremor oral : Excessive dosage: Angina pectoris, tachydysrhythmias Tremor
30
what do anti cholinergic drugs do ?
Improves lung function by blocking muscarinic receptors in the bronchi, thereby reducing bronchoconstriction
31
action and use of anticholinegic drugs
Improves lung function by blocking muscarinic receptors in the bronchi, thereby reducing bronchoconstriction Therapeutic effects begin within 30 seconds, reach 50% of maximum in 3 minutes, and persist about 6 hours
32
adverse effects of anticholinergic drugs
Dry mouth and irritation of the pharynx Glaucoma Cardiovascular events
33
tiotropium and ipratropium
Long-acting, inhaled anticholinergic agent approved for maintenance therapy of bronchospasm associated with COPD Not approved for asthma
34
tiotropium works by
Relieves bronchospasm by blocking muscarinic receptors in the lung
35
adverse effects of anticholinergic drugs
36
LABA/ glucocorticoids
Indicated for long-term maintenance in adults and children Not recommended for initial therapy
37
management of chronic asthma
step wise therapy : Step chosen for initial therapy is based on pretreatment classification of asthma severity, moving up or own is based off of asthma control
38
therapy for acute severe exacerbation
Oxygen—To relieve hypoxemia A systemic glucocorticoid—To reduce airway inflammation A nebulized, high-dose SABA—To relieve airflow obstruction Nebulized ipratropium—To further reduce airflow obstruction
39
management of copd 2 goals :
Reduce symptoms, thereby improving the patient’s health status and exercise tolerance Reduce risks and mortality by preventing progression of COPD and by preventing and managing exacerbations
40
pharmacological management of stable COPD
Bronchodilators Glucocorticoids Phosphodiesterase-4 inhibitors
41
management of a copd exacerbation
SABAs (specifically inhaled, either alone or in combination with inhaled anticholinergics) are preferred for bronchodilation during COPD exacerbations Systemic glucocorticoids Supplemental oxygen to maintain an oxygen saturation of 88% to 92%
42
what is allergic rhinitis ? symptoms ?
Inflammatory disorder of the upper airway, lower airway, and eyes Sneezing Rhinorrhea Pruritus Nasal congestion For some people: Conjunctivitis, sinusitis, and asthma
43
what is the pathophysiology of allergic rhinitis
Triggered by airborne allergens Allergens bind to immunoglobulin E (IgE) on mast cells Triggers release of inflammatory mediators Histamine, leukotrienes, prostaglandins
44
what kinds of drugs are used to treat rhinitis ?
Glucocorticoids (intranasal) Antihistamines (oral and intranasal) Sympathomimetics (oral and intranasal)
45
first choice for treatment ? what are some of the side effects ?
FLONASE/Fluticasone , highly effective for prevention and treatment has mild adverse effects- Drying of nasal mucosa or sore throat Epistaxis (nosebleed) Headache Rarely, systemic effects (adrenal suppression and slowing of linear pediatric growth)
46
oral antihistamines for rhinitis ? what are some of the adverse reactions ?
Does not reduce nasal congestion, effective when taken prophylactically and should be taken regularly when it is allergy season even with no symptoms mild sedation will be seen with first gen medications and less is seen with second gen meds
47
Intranasal Antihistamines: Azelastine and Olopatadine
treats rhinitis in kids over 12 and adults
48
intra nasal antihistamine Systemic absorption can be sufficient to cause
somnolence Nosebleeds Anticholinergic effects Unpleasant taste
49
what does Intranasal Cromolyn Sodium do ?
Reduces symptoms by suppressing release of histamine and other inflammatory mediators from mast cells Prophylaxis
50
administering intranasal cromolyn
Administer before symptoms start Response develops in 1 to 2 weeks Minimal adverse reactions: Less than with any other drug for allergic rhinitis
51
Sympathomimetics
Reduce nasal congestion (do not reduce rhinorrhea, sneezing, or itching, Activate alpha1-adrenergic receptors on nasal blood vessels
52
adverse effects of Sympathomimetics
Rebound congestion CNS stimulation Cardiovascular effects and stroke Abuse
53
topical vs oral administration of Sympathomimetics
Topical agents act more quickly than oral agents and are usually more effective Oral agents act longer than topical preparations Systemic effects occur primarily with oral agents; topical agents usually elicit these responses only when dosage is higher than recommended
54
rebound congestion will be commonly seen with
prolonged use of topical agents but not with oral agents
55
Antihistamine-sympathomimetic combinations
Claritin D Allegra D Zyrtec D
56
what is an antitussive ?
Drugs that suppress cough
57
Nonopioid antitussives
Dextromethorphan Diphenhydramine Benzonatate
58
opoid antitussive
Codeine and hydrocodone
59
what are expectorants ?
Renders cough more productive by stimulating flow of respiratory tract secretions ex) Guaifenesin [Mucinex, Humibid]

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